The Swedish Agency for Public Management

Evaluation of joint management by knowledge for the healthcare and social services; Interim Report (2016:13)

On 1 July 2015 a council was established with nine authorities that have central information for the central governmental knowledge management for healthcare and social services. The authorities' collaboration with each other and with the principals, county councils and municipalities is governed by the ordinance (2015:155) on government knowledge management for healthcare and social services. Statskontoret (The Swedish Agency for Public Management) assesses whether the aim of the ordinance is achieved, on commission by the government.

This report is an interim report. Statskontoret will submit a final report by 1 November 2018.

Statskontoret's overall assessment

Statskontoret's overall assessment is that the authorities which collaborate in the council have initially taken appropriate measures, although it is too early to see any concrete results. However, their collaboration faces challenges that require the authorities to make strategic choices in the future, which we develop below.

Initial step taken toward joint knowledge management

Statskontoret considers that the authorities have taken a first step toward joint knowledge management. Collaboration between the authorities has been established and the authorities have accepted the overall priority of the principals.

The authorities are also working toward the objectives in the ordinance, which stipulate that knowledge management must be coordinated, efficient and adapted to the needs of the different professions and principals. Among other things, the authorities are working to improve their joint communication to the target groups. However, there is still a long way to go before the objectives are met. The work with adapting knowledge management to the needs of the beneficiaries is still at an early stage, for example.

The authorities need to change their perspective

In Statskontoret's opinion, relatively large changes in the authorities' work are required for knowledge management to be adapted to the needs of healthcare and the social services, and for it to be a real support in the work with evidence-based practice. It requires a change in perspective on the part of the authorities to give the professions more space. The top-down perspective must be replaced with an open dialogue. There is otherwise a risk that knowledge support does not actually support the professions, which in turn means that central government control does not have any real effect.

Collaboration faces challenges

Collaboration is required on several levels if the objectives of knowledge management are to be achieved. Statskontoret notes that this collaboration faces major challenges. All the authorities on the council do not feel equally concerned by the commission and they do not have any previously established collaboration to fall back on. Statskontoret considers that the regulation of collaboration in the ordinance gives the authorities a better prospect of meeting the challenges. Knowledge management is clearly formulated, its strategic direction is stated and the division of responsibilities is made clear through the management of each organisation being responsible for the collaboration. These conditions facilitate the collaboration process.

Need for strategy among priorities

Statskontoret considers that the authorities need to identify the key issues to ensure that knowledge control will reflect the objectives and act as a support for operations. The council needs to draw up a strategy that states what priorities the council is going to make. The council also needs to make clear how the authorities that are only partly included in knowledge management can best contribute to the work.

Need to systematize proven experience

In a number of areas there is no base of scientific knowledge, which the authorities are taking measures to address. However, it is important that the organisations in these cases are given guidance, pending a more stable knowledge base. The organisations need to be given information on whether there is proven experience that can be followed meanwhile. The authorities on the council should therefore give priority to the work of obtaining local knowledge and systematize proven experience to a greater extent.

Need for better cooperation on scientific supporting data

The authorities concerned have not yet taken on their roles since the Government drafting committee on medical and social evaluation (SBU) was given overall responsibility for scientific knowledge overviews. For example, the collaboration required between the National Board of Health and Welfare and SBU in establishing ­national guidelines has not been completely satisfactory. There is thus a risk that the work with national guidelines is not as efficient as intended.

Need for long-term financing of website

E-administration initiatives can be costly for individual authorities and the expected benefits rarely occur immediately. Statskontoret considers that the authorities concerned should decide on how an updated website with improved data and functions shall be financed in the long-term. For example, the authorities could gain some inspiration from the joint initiatives that were developed during the earlier E-delegation.

Need for integrated knowledge management

Collaboration is often required between healthcare and social services for individuals to receive good care from both instances. The council has an important task in drawing attention to the links between the two areas. Statskontoret notes that the council initially chose to integrate work between healthcare and social services, but that some feel that the issues should be divided more. Regardless of how the authorities in the council chose to organise this work in the future, Statskontoret considers that it is urgent that they take into account the links between the social services and healthcare.

Proposal to the council authorities and the government

Statskontoret proposes that the authorities working together on the council:

  • develop a strategy that states what priorities the council will make and how the authorities that are only partly affected by knowledge management can best contribute to the work,
  • give priority to acquiring knowledge at the local level and systematising proven experience in order to identify the best available knowledge,
  • decide how a future website can be financed,
  • find forms of effective collaboration in the work with knowledge overviews ­based on SBU's overall responsibility,
  • ensure that, regardless of how they choose to organise the work of the council, they take into account the links between healthcare and the social services.

The establishment of the council does not involve any principle changes to the government's control. However, the government needs to consider the ordinance when formulating official appropriations documents and special commissions so that the authorities in the council are managed consistently.